Neuropediatric Department, Christian-Albrechts-University, Kiel, Germany.
Pain. 2009 Dec 15;147(1-3):132-40. doi: 10.1016/j.pain.2009.08.028. Epub 2009 Sep 30.
In adult patients with migraine, transcranial magnetic stimulation (TMS) has been used to examine cortical excitability between attacks, but there have been discrepant results. No TMS study has examined cortical excitability in children or adolescents with migraine. Here, we employed TMS to study regional excitability of the occipital (phosphene threshold [PT] and suppression of visual perception) and motor (resting motor threshold and cortical silent period) cortex in ten children suffering from migraine without aura and ten healthy age-matched controls. Patients were studied 1-2 days before and after a migraine attack as well as during the inter-migraine interval. The motion aftereffect was also investigated at each time-point as an index of cortical reactivity to moving visual stimuli. Migraineurs had lower PTs compared to healthy participants at each time-point, indicating increased occipital excitability. This increase in occipital excitability was attenuated 1-2 days before a migraine attack as indicated by a relative increase in PTs. The increase in PTs before the next attack was associated with a stronger TMS-induced suppression of visual perception and a prolongation of the motion aftereffect. Motor cortex excitability was not altered in patients and did not change during the migraine cycle. These findings show that pediatric migraine without aura is associated with a systematic shift in occipital excitability preceding the migraine attack. Similar systematic fluctuations in cortical excitability might be present in adult migraineurs and may reflect either a protective mechanism or an abnormal decrease in cortical excitability that predisposes an individual to a migraine attack.
在偏头痛的成年患者中，经颅磁刺激（TMS）已被用于在发作之间检查皮质兴奋性，但结果存在差异。没有 TMS 研究检查过偏头痛的儿童或青少年的皮质兴奋性。在这里，我们使用 TMS 研究了 10 名偏头痛无先兆儿童患者和 10 名年龄匹配的健康对照者的枕叶（闪光阈值 [PT] 和视觉感知抑制）和运动皮质（静息运动阈值和皮质静息期）的区域兴奋性。患者在偏头痛发作前 1-2 天、偏头痛发作期间和偏头痛发作间隙期接受了检查。在每个时间点还研究了运动后效，作为对运动视觉刺激的皮质反应性的指标。偏头痛患者在每个时间点的 PT 均低于健康参与者，表明枕叶兴奋性增加。这种枕叶兴奋性的增加在偏头痛发作前 1-2 天减弱，表现为 PT 相对增加。下一次攻击前 PT 的增加与 TMS 诱导的视觉感知抑制增强和运动后效延长有关。患者的运动皮质兴奋性没有改变，并且在偏头痛周期中没有变化。这些发现表明，儿童偏头痛无先兆与偏头痛发作前枕叶兴奋性的系统性变化有关。皮质兴奋性的类似系统性波动可能存在于成年偏头痛患者中，可能反映了一种保护机制或异常降低的皮质兴奋性，使个体容易发生偏头痛发作。
